Strengthening Constitutional Self-Government

No Left Turns


Romneycare and Obamacare

In a previous post I argued that the version of Obamacare that passed sure seemed similar to Romneycare  They are more similar than different, but the differences are important too.  Romneycare was a good faith effort at a long-term Left/Right compromise on heath care policy. The Left got a plausible commitment to universal health insurance coverage through the combination of an individual insurance mandate and subsidies along with a series of coverage mandates that turned health insurance into something like (but not quite) comprehensive medical prepayment.  The Right got to have the insurance subsidies channeled through private insurance companies and with no formal government price controls.

Obamacare is best described as a kind of Romneycare designed to fail and create public demand for a single-payer system.  Romneycare included coverage mandates that made health insurance more expensive but it didn't give unelected bureaucrats the power to indirectly force insurance companies to enact huge premium increases.  Obamacare also creates a weaker individual mandate than Romneycare.  This (combined with the soon-to-be illegality of insurance companies denying coverage) would make it inviting for younger people to avoid getting insurance, pay the fine and only sign up for insurance when they get sick.  This would of course raise premiums on those who comply with the law and buy insurance.  That is why liberals were so upset about the loss of the public option.  Bureaucrats would have been able to destroy the private insurance companies by forcing them to raise premiums and thereby drive customers to the government-run insurance program creating a virtual government monopoly in health insurance.  Now liberals will have to try to direct the public discontent that Obamacare will create toward passing a yet another program - one that will establish full government-run medicine.

The thing is, trying to rebuild Obamacare in the image of Romneycare isn't a good idea.  The better designed Romneycare is still leading to rising premiums, and evasion of the individual mandate,  there are longer waiting periods for seeing a doctor, and emergency room visits are on the rise.  The problem is the model of government both subsidizing and (on the state level pre-Obamacare) mandating a costly and inefficient system of health insurance that amounts to comprehensive prepayment for noncatastrophic medical services.  Romneycare, for all of its good intentions, makes that problem worse. 

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